Provider Demographics
NPI:1124572227
Name:ALBANY PSYCHOLOGICAL SERVICES FOR EATING DISORDERS, PLLC
Entity Type:Organization
Organization Name:ALBANY PSYCHOLOGICAL SERVICES FOR EATING DISORDERS, PLLC
Other - Org Name:HPA/LIVEWELL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:N
Authorized Official - Last Name:MORISON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:518-218-1188
Mailing Address - Street 1:207 WASHINGTON STREET SUITE 202
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-8112
Mailing Address - Country:US
Mailing Address - Phone:518-218-1188
Mailing Address - Fax:518-218-1988
Practice Address - Street 1:207 WASHINGTON ST STE 202
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-8112
Practice Address - Country:US
Practice Address - Phone:518-218-1188
Practice Address - Fax:518-218-1988
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALBANY PSYCHOLOGICAL SERVICES FOR EATING DISORDERS, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-08
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YM0800X, 103TC0700X, 103TP2701X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty